Divorce Services Forms and Information On Payment & Insurance

Initial Appointment Form

You may download the following forms, which are provided as PDFs, should you wish to familiarize yourself with them before your first appointment. It will save time in your first appointment if you print and fill in these forms, and bring them with you, rather than filling them out during your appointment. In particular, the parenting plan form is a bit long and the custody evaluation form is very long; if you cannot fill these out before the day of your appointment, please plan to come at least 30 minutes in advance of your appointment time to complete the forms at the office. Your first appointment cannot begin until the forms are filled out.

Clients seeking Divorce Consult Services to include: an informational process consult to determine what type of divorce process might work best for you; communication skill building to prep for meetings; preparation and assistance through the process; child specialist consultation (with the exception of parenting plan consults); and/or parent coordinator services (coaching for cooperative co-parenting), use the first two forms below.

Clients seeking Parenting Plan Consultation, use the second and third forms below. (This is for clients who come in specifically for us to mediate their parenting plan / custody schedule. If you are uncertain if this applies to you, it would be fine to fill out the shorter form #1 below for a consult and do the longer form later if we determine we need it.)

Clients seeking a Custody Evaluation need ONLY the TWO forms below that relate to custody (forms 4 & 5).

Clients seeking Divorce Mediation, use the last form below only.

(Clients seeking therapy should click here to go to Clinical Forms.)
1. LEPAGE ASSOCIATES DIVORCE CONSULTANT SERVICE AND FEE AGREEMENT
Information Concerning The Practice, Financial Arrangements, and Confidentiality

2. NORTH CAROLINA NOTICE FORM
Notice of Psychologists’ Policies and Practices
to Protect the Privacy of Your Health Information

3. LEPAGE ASSOCIATES SERVICE AND FEE AGREEMENT FOR PARENTING PLAN CONSULTS
Information Concerning The Practice, Financial Arrangements, and Confidentiality

4. CUSTODY EVALUATION SERVICE AND FEE AGREEMENT
Information Concerning The Practice, Financial Arrangements, and Confidentiality

5. CONSENT TO RELEASE & EXCHANGE INFORMATION FOR CUSTODY EVALUATION

6. DIVORCE MEDIATION SERVICE AND FEE AGREEMENT
Information Concerning The Practice, Financial Arrangements, and Confidentiality

(If you plan to utilize our mediation/facilitation services with attorney involvement, click here for a sample attorney contract for collaboration with Lepage Associates.)
Schedule of Fees

Informational Consult (to determine what model fits your needs): $160.00 per hour

All other Divorce Services: $200.00 per hour

Parenting Plans / Custody & Visitation Evaluations:

Click here for our tiered approach, which ranges in price from $200.00 per hour to $2,500 – $9,750 flat fees depending on services sought. (Please note our fees are kept at below the local average for parenting plans and custody evaluations, and are thus very reasonable.)

Click here to return to Services for Separation & DivorceDivorce Services Forms and Information On Payment & Insurance

Click here to go to Clinical Services / Therapy & Evaluation